经巩膜缝线固定眼内人工晶状体的撕囊自动化角膜内皮移植术。
Descemet-stripping automated endothelial keratoplasty in eyes with transscleral-sutured intraocular lenses.
机构信息
From the Department of Ophthalmology (Yazu, Yamaguch, Dogru, Ishii, Satake, Shimazaki), Ichikawa General Hospital, Tokyo Dental College, Chiba, and the Department of Ophthalmology (Yazu, Yamaguchi, Dogru, Shimazaki), Keio University School of Medicine, Tokyo, Japan.
From the Department of Ophthalmology (Yazu, Yamaguch, Dogru, Ishii, Satake, Shimazaki), Ichikawa General Hospital, Tokyo Dental College, Chiba, and the Department of Ophthalmology (Yazu, Yamaguchi, Dogru, Shimazaki), Keio University School of Medicine, Tokyo, Japan.
出版信息
J Cataract Refract Surg. 2016 Jun;42(6):846-54. doi: 10.1016/j.jcrs.2016.02.044.
PURPOSE
To compare the clinical outcomes and complications of Descemet-stripping automated endothelial keratoplasty (DSAEK) with a transscleral-sutured intraocular lens (IOL) and solitary DSAEK.
SETTING
Department of Ophthalmology, Tokyo Dental College, Chiba, Japan.
DESIGN
Retrospective case series.
METHODS
Cases with simultaneous transscleral-sutured IOLs or post-transscleral-sutured IOLs and solitary DSAEK cases were studied. The logMAR acuity, astigmatism, endothelial cell density (ECD), graft survival rate, and complications (eg, IOL dislocation, cystoid macular edema [CME]) were analyzed.
RESULTS
Thirty-seven DSAEK cases with simultaneous transscleral-sutured IOLs or post-transscleral-sutured IOLs and 147 solitary DSAEK cases were evaluated. The logMAR corrected distance visual acuity (CDVA) improved significantly at 24 months, from 1.34 ± 0.49 (SD) to 0.48 ± 0.38 after DSAEK with transscleral-sutured IOLs and from 1.17 ± 0.69 to 0.17 ± 0.25 after solitary DSAEK. The logMAR CDVA after DSAEK with transscleral-sutured IOLs was significantly worse than that with solitary DSAEK at 6, 12, and 24 months (P < .01). The postoperative astigmatism with DSAEK with transscleral-sutured IOLs was significantly higher than with solitary DSAEK because of the larger sclerocorneal incision (P < .02). There were no significant differences in ECD or graft survival rates between DSAEK with transscleral-sutured IOLs and solitary DSAEK. The incidence of CME in DSAEK with transscleral-sutured IOLs (4/37 eyes [11%]) was higher than with solitary DSAEK (2/147 [1.4%]) (P = .02). The CME resolved with topical diclofenac and sub-Tenon injection of triamcinolone acetonide in all eyes.
CONCLUSION
The graft survival rates after DSAEK with transscleral-sutured IOLs were equivalent to those after solitary DSAEK, although the incidence of CME was higher than after solitary DSAEK.
FINANCIAL DISCLOSURE
None of the authors has a financial or proprietary interest in any material or method mentioned.
目的
比较经巩膜缝合式人工晶状体（IOL）与单纯 Descemet 撕囊自动内皮角膜移植术（DSAEK）的临床效果和并发症。
设置
日本东京齿科大学眼科。
设计
回顾性病例系列。
方法
研究同时行经巩膜缝合式 IOL 或巩膜后缝合式 IOL 与单纯 DSAEK 的病例。分析 logMAR 视力、散光、内皮细胞密度（ECD）、移植物存活率和并发症（如 IOL 脱位、囊样黄斑水肿[CME]）。
结果
37 例 DSAEK 同时行经巩膜缝合式 IOL 或巩膜后缝合式 IOL，147 例单纯 DSAEK。经巩膜缝合式 IOL 与单纯 DSAEK 后 24 个月 logMAR 矫正远视力（CDVA）分别显著改善，从 1.34±0.49（SD）至 0.48±0.38 和从 1.17±0.69 至 0.17±0.25。经巩膜缝合式 IOL 与单纯 DSAEK 后 6、12 和 24 个月的 logMAR CDVA 差异均有统计学意义（P<.01）。由于巩膜角膜切口较大，经巩膜缝合式 IOL 与单纯 DSAEK 术后散光均较高（P<.02）。经巩膜缝合式 IOL 与单纯 DSAEK 的 ECD 或移植物存活率差异无统计学意义。经巩膜缝合式 IOL 与单纯 DSAEK 的 CME 发生率分别为 4/37 眼（11%）和 2/147 眼（1.4%），经巩膜缝合式 IOL 的 CME 发生率较高（P=.02）。所有患者的 CME 均经局部双氯芬酸钠和曲安奈德经 Tenon 下注射消退。
结论
经巩膜缝合式 IOL 与单纯 DSAEK 后的移植物存活率相当，尽管 CME 的发生率高于单纯 DSAEK。
利益冲突
无作者在文中提及的任何材料或方法中有经济或所有权利益。
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